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Application of recent discoveries of physiological bases for phantom limb and phantom body pain to chronic pain mechanisms and treatments
PAlNINPSYCR0SCMATICDISORDERS B. !2!qar 1, K. Elg& 2". mt
INGENERAL
P-ICE * of BehaviouralSciences in Medicine1, Universityof Oslo,Norway 2. H. Lundbeck A/S, Drmsveien 342, 1342 Lysaker,Norway. m of Investigation: An ep&miological-registration of patientswith psychosomatic disorders(PS)in generalpractice,includingsyn@xns/ synds, personality, triggeringfactors,consequences and treatnent. Methods: Definitionof PS: Stateswhere enrotional factors,due to strengthor duration,were consideredto be an importantfactorin functionaldisturbances or structuralchanges.20 Gps filledin a 4 paged form for all patientswith PS on 10 fixeddays, coveringthe itemsabove. Results:657 patientswith PS were registered,14% of the consultations. Eacment had 4.6 syn@xs frcana list of 47. 496 patients (75%)bad pain, 331 wz4Ie.n and 163 men - aostlyassociatedwith disordersin the musculoskeletalsystemandlccated in the head,neck, shoulder,backand abdanen.Generalisedtensionwas found in nearly 50%. Anxiety,depression andastheniawtareregisteredatthesane rate,oftenas anADAsynti. In 55% therewereobjectivefindings. Approxin-atelyathirdhadthe symptansfor a year or nore. 41% also had anotherdisorder.Men and m had a differentsyqx&xnpattern.Triggeringfactorsalso differedstrongly, withnensproblems relatedrrxetoworkandwcanens nore to the family. Conclusion:With a broad definitionof PS, pain was the nxostfrequent syqtan, mostlyassociatedwith disordersin the musculoskeletal system. In the raajority of cases therewere triggeringproblemsand impaired function. APPLICATIONOF RECENTDISCOVERIESOF PHYSIOLOGICAL BASES FOR PHANMM LIMB AND PRANTOMBODY PAIN TO CHRONICPAIN MECRANISMSAND TREATMENTS.R.& Sherman, J.L. Ernst*, C.J. Sherman*,and G.M. Bruno*.Departmentof Clinical DD Eisenhower Medical Center, Ft Gordon, GA 30905, USA Investigation, Aim of investigation:To identify physiological markers and mechanisms for phantom pain. Methods: Thermographic recordings of near-surface body temperature were performed on thirty consecutive amputees who reported stump and/or phantom limb pain. They were also performed on 13 consecutive patients diagnosed as having completely transected spinal cords who reported pain apparently emanating from areas no longer connected to the brain through the spinal cord. Sets of thermograms for each subject were evaluated by measuring the number of degrees difference between painful areas and both paired areas and surrounding tissue. Many of the sets were also evaluated by a ten member panel blind to the subjects' pain reports. Results: Among the amputees, we found that a consistent inverse relationship occurred between intensity of pain and stump temperature relative to the that of the intact limb for burning, throbbing, and tingling descriptions of both phantom and stump pain. Neither of these relationships held for other descriptions of either phantom or stump pain. Among the SC1 subjects, the was a virtually exact correspondence between an localized increase in temperature and the location of reoorted nain which did not corresnond to dermatomes. Concl&ions: When the results of both studies are related, the existence of a major pathway for pain outside the spinal cord is highly plausible.These results affect not only our theoretical approach to pain but our day to day way of evaluating chronic pain patients with no apparent physiological basis for their pain.
INGENERAL
P-ICE * of BehaviouralSciences in Medicine1, Universityof Oslo,Norway 2. H. Lundbeck A/S, Drmsveien 342, 1342 Lysaker,Norway. m of Investigation: An ep&miological-registration of patientswith psychosomatic disorders(PS)in generalpractice,includingsyn@xns/ synds, personality, triggeringfactors,consequences and treatnent. Methods: Definitionof PS: Stateswhere enrotional factors,due to strengthor duration,were consideredto be an importantfactorin functionaldisturbances or structuralchanges.20 Gps filledin a 4 paged form for all patientswith PS on 10 fixeddays, coveringthe itemsabove. Results:657 patientswith PS were registered,14% of the consultations. Eacment had 4.6 syn@xs frcana list of 47. 496 patients (75%)bad pain, 331 wz4Ie.n and 163 men - aostlyassociatedwith disordersin the musculoskeletalsystemandlccated in the head,neck, shoulder,backand abdanen.Generalisedtensionwas found in nearly 50%. Anxiety,depression andastheniawtareregisteredatthesane rate,oftenas anADAsynti. In 55% therewereobjectivefindings. Approxin-atelyathirdhadthe symptansfor a year or nore. 41% also had anotherdisorder.Men and m had a differentsyqx&xnpattern.Triggeringfactorsalso differedstrongly, withnensproblems relatedrrxetoworkandwcanens nore to the family. Conclusion:With a broad definitionof PS, pain was the nxostfrequent syqtan, mostlyassociatedwith disordersin the musculoskeletal system. In the raajority of cases therewere triggeringproblemsand impaired function. APPLICATIONOF RECENTDISCOVERIESOF PHYSIOLOGICAL BASES FOR PHANMM LIMB AND PRANTOMBODY PAIN TO CHRONICPAIN MECRANISMSAND TREATMENTS.R.& Sherman, J.L. Ernst*, C.J. Sherman*,and G.M. Bruno*.Departmentof Clinical DD Eisenhower Medical Center, Ft Gordon, GA 30905, USA Investigation, Aim of investigation:To identify physiological markers and mechanisms for phantom pain. Methods: Thermographic recordings of near-surface body temperature were performed on thirty consecutive amputees who reported stump and/or phantom limb pain. They were also performed on 13 consecutive patients diagnosed as having completely transected spinal cords who reported pain apparently emanating from areas no longer connected to the brain through the spinal cord. Sets of thermograms for each subject were evaluated by measuring the number of degrees difference between painful areas and both paired areas and surrounding tissue. Many of the sets were also evaluated by a ten member panel blind to the subjects' pain reports. Results: Among the amputees, we found that a consistent inverse relationship occurred between intensity of pain and stump temperature relative to the that of the intact limb for burning, throbbing, and tingling descriptions of both phantom and stump pain. Neither of these relationships held for other descriptions of either phantom or stump pain. Among the SC1 subjects, the was a virtually exact correspondence between an localized increase in temperature and the location of reoorted nain which did not corresnond to dermatomes. Concl&ions: When the results of both studies are related, the existence of a major pathway for pain outside the spinal cord is highly plausible.These results affect not only our theoretical approach to pain but our day to day way of evaluating chronic pain patients with no apparent physiological basis for their pain.